You may be asking
just how in the heck you find a therapist? Moreover, how do you know
whether they're competent or not? or Why do you need a therapist anyway?
Well, those are very good questions and, hopefully, you'll find some
answers here.

Editor's Note:
Don't worry, there ARE actually links to a couple lists of therapists
on this page. You can scroll down to the links if you like, but you
should really read the other information about therapists and therapy
on this page before you go contacting any of them. :-)

WHY DO YOU
NEED A THERAPIST?

"Need"
may be a strong word, as there are certainly many well-adjusted transgender
people out there who arguably don't need psychotherapy. However, there
are also many who find psychotherapy beneficial, especially if one suffers
from what are often termed "peripheral problems" (such as
Depression, Bipolar Disorder, OCD, etc.) that may or may not have anything
to do with being Gender Dysphoric, but nonetheless adversely affect
the quality of the individual's life.

The other reason
to see a therapist is because, if you are transitioning "by the
book" (i.e., following the Harry Benjamin Standards
of Care), psychological evaluations are a requirement for professional
recommendations/referrals for things like HRT and GRS/SRS.

Technically you
can transition without undergoing psychotherapy, or in some cases for
people who are well-adjusted and already living in role and/or on HRT,
a one or two visit "evaluation" amounting to little more than
a formality may suffice.

Actually it is possible
to transition without even consulting a therapist, and many people do
go that route. HRT drugs can often be obtained via prescriptions through
a family doctor or some other medical specialty, or (more commonly)
purchased from overseas with or without a prescription. Surgeons (particularly
in Asia) who perform SRS/GRS or other feminization surgical procedures
often do not require letters of recommendation from therapists, mostly
because psychotherapy is not as common in Asia as it is in the West.

While this may be
the more expedient method for those who are free of psychological issues,
unfortunately it also means transition can be more expedient for people
who DO have problems - including those who may not have been ideal candidates
for transition, HRT, and/or GRS in the first place.

Even if a person
was well-adjusted and free of psychological issues before transition,
there are problems that can surface during, or because, of transition
which may need to be addressed. For example, many people suffer rejection
by friends and family, or relationship problems with thier children
and/or a significant other. If a transitioner does not pass well there
may be issues with social interactions, body image, self-esteem, depression,
etc. Having a therapist to help one deal with the issues that crop up
DURING transition is a possibility sometimes overlooked by those who
initially avoid psychotherapy.

Another often overlooked
benefit of seeing a gender therapist is the fact that they've been privy
to the transition experiences of other transgender people, so they may
be able to offer coping methods or points-of-view that had not occurred
to you. Not to mention they likely know which doctors and businesses
are trans-friendly, if not by professional reputation than by "word
of mouth" from their patients.

HOW DO YOU
KNOW A THERAPIST IS QUALIFIED?

This is the trickiest
question. Ask most transgender people and they will tell you to seek
the help of a QUALIFIEDGENDER therapist.
Many a warning has been issued to a "newbie" (i.e., someone
just starting out with transition) about going to a therapist who has
no prior experience treating people with Gender Identity Disorders.
The consensus is that a "general" therapist is more apt to
misdiagnose a gender patient, focus on the peripheral issues, and/or
act as a "gatekeeper" to hamper the patient's transition.

If you look below
you will see a number of "screening questions" to ask a therapist
once you've hunted one down. Remember, though, that one of your GRS/SRS
letter writers must, according to the Harry Benjamin Standards of Care,
be from a doctorate-level clinical professional:

"If the
first letter is from a person with a master's degree (M.A.), the second
letter should be from a psychiatrist (M.D.) or a clinical psychologist
(Ph.D.). If the first letter is from the patient's psychotherapist,
the second letter should be from a person who has only played an evaluative
role for the patient."

Which leads to the
question of just what in the heck do all those letters behind a therapist's
name mean anyway? Well first of all, you should know that not all therapists
are doctors. They may be social workers, licensed counselors, or people
with an education level below that of the "doctorate" level.
This does not, however, mean that these therapists are less qualified
than another who holds a doctorate - especially if that doctorate is
not in a clinical mental health field!

Some of the common
letters you will find behind the names of therapists include:

M.D. -
Most people know this one, it means "Medical Doctor." While
medical doctors are required to learn some basic Psychology, this
does not usually qualify a medical doctor to practice therapy in a
mental health setting, and certainly not to treat as complex an issue
as GID. Psychiatrists are usually medical doctors who have specialized
in the field of mental health, in much the same way that a "Cardiologist"
specializes in heart health. A Doctor of Psychiatry may also be "Board
Certified" or "Board Eligible" in Psychiatry or even
Child Psychiatry.

D.O.
- Doctor of Osteopathy. This is very similar to an M.D. Osteopaths
generally get the same residency training as medical doctors. Their
medical schools include additional training in physical manipulation
techniques somewhat similar to chiropractic. Editor's Note:A reader sent this in, "Well, for all practical
AND legal purposes the M.D. and D.O. degrees conferred in the United
States are equivalent in what concerns the practice of medicine, and
that includes Psychiatry. As such, a D.O. who is board certified in
Psychiatry (and there are many who are) is just as qualified in providing
Gender Therapy as a M.D. with the same qualifications, with the provision
for both types of practitioner, that they have an interest and some
training in the area (the same provision applies to any other type
of licensed therapist, of course)."

Ph.D.
- This means "Doctor of Philosophy." You should
ask your potential therapist if his or her doctorate degree is in
Clinical Psychology (with a focus on research and practice), Counseling
Psychology (with a focus on practice in less pathological populations),
School Psychology (although many school psychologists do not get a
doctorate), or just Psychology (many experimental and social psychologists
at colleges have this), or the more recent psychological field known
as "Sexology" (see below under ones to avoid). Just because
a therapist has a Ph.D after his or her name and a"Dr."
in front of it, doesn't mean they are an expert in a mental health
field - that doctorate might be in "Art" or "Literature."
Which is why it is important to know what concentration was in which
the doctor earned his or her degree.

Psy.D.
- Doctor of Psychology. A clinical psychology degree which places
more emphasis on practice than research. Psy.D. programs developed
to train practitioners who would keep up with research but might never
do much research of their own.

Ph.D.(c)
or Psy.D.(c) - The "(c)" means "candidate."
It indicates that the individual is a "doctoral candidate"
but has not yet actually earned their Ph.D. If you see this after
a therapist's name make sure to look for some other legitimate therapy
credentials - for they may be practicing under a Masters Degree they
are in the process of "upgrading" to a Doctorate Degree,
or have experience as a licensed therapist or counselor under some
other credentials (because a Masters or Doctorate degree are not prerequisites
for obtaining a license to practice counselling others). If the Ph.D.(c)
stands all by itself, though, you may have to question whether they
are actually qualified to treat your gender problem, either because
he or she has insufficient education and/or experience.

One thing
of interest to many gender patients is how much difficulty and expense
they may have in obtaining hormones for HRT. A Psychiatrist, being
an M.D., can usually write prescriptions for drugs - including hormones
- while a Psychologist, being a Ph.D. or Psy.D., cannot. While this
may save some money and time by not having to deal with a referral
and added expenses of seeing an Endocrinologist, it may also mean
substandard or absent monitoring (i.e., limited or no lab testing).
Also one consideration is the major criticism of Psychiatrists (especially
in the United States) that they over-prescribe medications which only
address the symptoms of a problem (such as depression), rather than
doing the probing to discover the cause of the problem. If you are
only looking for letters of recommendation and prescriptions you'll
probably be satisfied with a Psychiatrist. If you actually want to
explore, understand, and deal with the root cause of your psychological
issues (especially if you are against medicating psychological problems),
you may find a Psychologist more to your liking.

D.S.W.
- Doctor of Social Work. An advanced social work degree,
often held by educators in social work.

Ed.D.
- Doctor of Education. Many Schools of Education confer this degree.
A recipient can be a psychologist, an educational administrator,
or someone in another education-related field. Definitely ask any
practicing therapist what their field of study was!

D.Sc.
- Doctor of Science. More common in Canada than in the U.S.
I'm not entirely clear on the distinction between this and a Ph.D.
It is a legitimate degree though.

Masters
Degree - Many therapists have masters degrees in
a mental health field. There are generally three forms:

MSW -
Masters of Social Work. This is conferred on someone who completed
a master’s degree in social work by the university they attended.
It is the same as the PhD, which is awarded by an educational institution.
Not everyone with a master’s degree in social work alone or
other fields is sufficiently trained to conduct psychotherapy independently.

ACSW,
DCSW, BCD (and a number of others) These credentials are
conferred on someone by a professional organization. They are an attempt
to certify that the person who attains such credentials has some level
of competence usually by taking an exam of some kind. Those listed
above mean "Academy of Certified Social Workers," "Diplomate
of Clinical Social Workers," "Board Certified Diplomate
in Clinical Social Work" respectively.

LICSW,
LCSW, CSW (and others) – These are usually credentials
issued by the State Government signifying the individual is in possession
of a license or certification (hence the "L" and/or "C"
in the alphabet soup). In many (but not all) states, in order to practice
legally or to call oneself a particular title, a license is required.
The “I” in the clinical social worker’s license
is important as it signifies they are licensed at the highest level
and can practice independently. This means they do not need to be
supervised by another clinician and also means that is one less person
who would routinely know your business and private communications.
The ones above mean "Licensed Independent Clinical Social Worker,"
"Licensed Clinical Social Worker," and "Certified Social
Worker" respectively.

M.S.W.
- Masters in Social Work. This is the traditional degree
for Social Workers. In some states, the title LCSW is used for a Licensed
Clinical Social Worker (or one of the variations listed above).

M.Ed.
- Masters in Education. Many counselors have this degree or the similar
M.S.Ed. It is given by schools of education in almost any
field of Education.

Some states
also license Counselors, who may or may not have an advanced degree,
be sure to ASK if your goal is to obtain the necessary letters of
recommendation for GRS/SRS:

L.P.C.
identifies a Licensed Professional Counselor.

M.F.C.C.
is used in some states to identify a Marriage, Family, and
Child Counselor. A therapist with such credentials may be beneficial
to parents with a transgender child, or a transgender person with
a spouse.

M.S. or
M.A. - Masters of Science or Masters of Arts. These are the
traditional degrees given by "Colleges of Arts and Sciences"
In the United States a Masters degree in Psychology has not been considered
a "terminal degree." A psychologist (other than a School
Psychologist) generally needs a doctorate to be licensed. Some Canadian
provinces license psychologists with a Masters degree. A few states
are also beginning to do this.

Ed.S.
- Educational Specialist. This is a degree which involves more training
than a Masters degree and less than a doctorate. Some School Psychologists
have this degree, as do some counselors.

Physicians
generally pass "specialty boards" to become "board
certified in Psychiatry" or other specialties.

A.B.P.P
- Psychologists can also become board certified, but this
is an extra credential which many psychologist do not get. The "American
Board of Professional Psychology" allows psychologists who pass
their test to use these initials.

F.A.C.P.
- is a "Fellow of the American College of Physicians"Fellows in the ACP are
doctors who are dedicated to continuing education in medical practice,
teaching, or research. Fellowship is an honorary designation given
to recognize their ongoing individual service and contributions to
the practice of medicine. Nice to see after a name, since it means
your doctor is less likely to be working with outdated information
or techniques, but it's only of value if they are staying current
in a field of medicine relevant to your gender therapy.

In
most states there is no license requirement to simply call oneself
a therapist or psychotherapist.
Just about anyone can hang up a shingle. It is important that whom
ever you chose as a therapist that they be licensed. It is no guarantee
of good treatment but at least you have some minimum safeguards.

Ones You
May Wish To Avoid for Therapy:

The following
degrees are either inappropriate, insufficient, or just plain questionable
for anyone practicing as a therapist.

M.D.
- Medical Doctors who are not Psychiatrists or who do not have psychological
training or certifications.

D.O.
- just like with an M.D., check for some other qualifications to treat
your gender disorder.

Ph.D.(c)
- [ see above why you may want to ask some credential questions
of any therapist displaying this after his or her name - since it
means they are only a "doctoral candidate" that has not
yet obtained their degree]

J.D. -
Doctor of Jurisprudence - An attorney. Some mental health professionals
also have law degrees, so look for OTHER certifications besides this
doctorate!

D.Min,
Th.D, D.Div.. - A "Doctor of Ministry," "Doctor
of Theology," or "Doctor of Divinity." Or more basically
put, they are a minister - possibly a doctoral level pastoral counselor,
but not always. Note that MANY of these
degrees are bestowed by Bible Colleges that are not even accredited
institutions of higher learning. While many ministers
these days do have some training in psychology they are certainly
not knowledgeable enough to counsel people in the same way a Psychologist
can. Furthermore, many of these "Pastoral Counselors"
provide counsel that his highly biased toward their own religious
beliefs. Given that most mainstream religions have very negative
views of transgenderism, it is strongly recommended that such "therapists"
be avoided.

M.Div.
- Masters of Divinity - another degree that ministers get - some of
whom are pastoral counselors. Again, it is the opinion of the author
of this web site that transgender patients should avoid "faith-based"
counseling due to the negative views most mainstream religions hold
concerning transgenderism.

D.C.H.
- Doctorate of Clinical Hypnotherapy. Certainly not a standard doctorate.
It is offered by the American Institute of Hypnotherapy which is located
at www.hypnosis.com. This degree
should not be equated with the above degrees. In fact, I read of a
story where one person - as a joke - got a dog (yes, a dog) "Board
Certified" as a Doctor of Clinical Hypnotherapy. Even if you
believe in hypnotherapy, there's no evidence it is effective in treating
GID.

N.D.
- Naturopathic Doctor. They are trained (but to what extent varies
greatly) in subjects such as anatomy, physiology, counseling, dietary
evaluations, nutrition, herbology, acupressure, muscle relaxation
and structural normalization, homeopathy, iridology, exercise therapy,
hydrotherapy, oxygen therapy and thermal therapy. Some practitioners
are also trained in additional specialties such as acupuncture or
natural childbirth. This "doctorate" also should not be
equated with M.D. or Ph.D. given the un-accredited institutions that
award (or outright sell) Naturopathic Medicine credentials. While
some may act as counselors (usually "mind/spiritual" or
"whole body health" type counselors), they would not be
an appropriate or qualified choice for gender therapy.

Other initials
stand for "certifications" in certain areas. A certification
is similar to a license, but with a more limited scope of practice.
Some common certifications are:

CSAC -
Certified Substance Abuse Counselor. This is someone with extra training
in substance abuse. They generally have at least a Bachelors degree
(the basic four year college degree). In most states they cannot practice
independently.

CAC
- Certified Alcoholism Counselor. Similar to a CSAC, but with an emphasis
in alcohol.

While the
above certifications may be of value to transgender patients who also
have substance abuse problems in addition to (or becuase of) a Gender
Identity Disorder, a substance abuse or alcoholism counselor certification
would not be enough qualification to treat a GID as well.

B.C.F.E.
- Some specialty boards are suspect because they allow almost anyone
to pay a hefty fee and get the credential. Until recently many professionals
could use these initials with modest training and without passing
any test. This board (the American Board of Forensic Examiners) has
plans to "certify" professionals in psychology and other
disciplines. The main advantage of this certification seems to be
the extra letters after a professional's name.

Sexologist
- may be a "Masters" or "Ph.D." This is a (some
say "dubious"), sub-field of Psychology. Part of the reason
it is contraversial is due to the fact some non-accredited schools
award degrees in this subject (link: read
about one of them), but also because some researchers in
this field have allegedly employed questionable (or overtly non-scientific)
methods or adhere to theories widely regarded as "fringe science,"
"junk science," or "pseudo-science." This does
not mean, however, that all therapists who hold a degree in Sexology
are bogus. But the fact that some in this field have conducted themselves
in a manner that is questionable or hold highly suspect credentials
should be cause by any gender patient to exercise caution if dealing
with a Sexologist, especially one who obtained his or her degree from
a non-accredited school. Take the time to question a Sexologist
about which gender theory or theories to which he or she subscribes.

Just "Doctor":
If you read an article which is written by a "doctor," and
the author does not specify what type of doctor they are, then be
skeptical. One prominent example is the popular radio personality
and advice columnist "Doctor Laura." She is not a psychologist
nor a psychiatrist. Her doctorate is acutally in "Physiology"
and she is licensed as an M.F.C.C. (Marriage, Family, and Child Counselor).
This doesn't mean she cannot dispense advice (anyone can offer advice,
after all), but it means that, technically speaking, her doctorate
doesn't qualify her to do the job she is doing.

Okay, so all of
that will help you determine whether or not they are a "qualified"
therapist or a quack. But what about the GENDER part of being a "Gender
Therapist?" That's where having a little "insider information"
can be helpful. Read on. . .

WHERE DO
YOU FIND A GENDER THERAPIST?

Well, you can call
the therapists in your area and ASK them if they've ever treated people
for Gender Identity Disorders before. You may just stumble across someone
who has the experience and credentials, but doesn't advertise the fact
that they conduct gender therapy.

The Harry Benjamin
International Gender Dysphoria Association will provide anyone a copy
of their Membership Directory for $10 (order
form), which will undoubtedly list some of the mental health professionals
who belong to the HBIGDA. However, it is important to remember that
many many therapists follow the Harry Benjamin Standards of Care for
treating GID, but do not actually belong to HBIGDA. It should also be
noted that membership in the HBIGDA does not require one be a psychologist!
They welcome membership applications from professionals in fields such
as medicine, psychology, sexology, social work, counseling, law, as
well as other interested persons who wish to be involved. Since the
HBIGDA doesn't require members (especially "supporting members")
to even have professional credentials, those who have illigitimate or
questionable credentials are also allowed to join. So membership in
the HBIGDA only tells you the prospective therapist is familiar with
gender disorders and their treatment guideline, it's still up to you
(the consumer) to practice due-diligence in checking a therapist's professional
credentials.

Then there's the
"tried-and-true" method which is to seek out the local Transgender
Community and ask other transsexual people who they are seeing for psychological
service - and who they believe you should avoid! Of course, what do
you do if you don't have (or at least don't know where) your "Transgender
Community" is? Thankfully we live in the "Information Age"
and you can likely find other transgender people in your area via the
Internet.

There are plenty
of places on the Internet where lists of therapists reported to (or
claiming to) treat gender patients may be found. None of these lists
is by any means comprehensive, but if you're lucky you may find a qualified
therapist in your area. This site has two such lists (which I put
in a box for the convenience of those lazy people that just scrolled
down without reading my pearls of wisdom):

If you simply cannot
locate a qualified GENDER therapist, then consider looking for a very
well qualified general therapist. Most therapists with experience treating
gender patients, at one time, had never treated one before. Just be
extra careful to avoid the pitfalls of seeking a therapist (discussed
below).

Another option,
especially if you are geographically isolated, may be to seek out a
therapist who will provide counseling by phone and/or Internet. Just
be careful to make sure they are legitimate before paying for session
time (for example, the therapist should also have a "brick and
mortar" practice as well).

SO YOU THINK
YOU FOUND A THERAPIST, NOW WHAT?

The Call
is Coming from Inside Your House!
First step is to contact a therapist you think may be able to help you.
This step can often be frightening and more than one transgender person
has had an anxiety attack while trying to work up the nerve to dial
the telephone, or immediately disconnected the phone call when someone
actually answered on the other end. The important thing to remember
is that the person you are calling is not only a professional, but one
bound by a code of ethics. They simply CANNOT talk about your issues
with anyone else without your permission. Just try not to gush about
your gender issues to the receptionist - ask to be transferred to the
therapist or his or her voicemail and leave a confidential message.
You don't have to give your life story, just say you are seeking "psychological
services for transgender therapy" and make sure to leave information
on how to contact you! Most therapists take great care to be discreet
when returning such a call, but if you are concerned about someone else
intercepting the message you should consider leaving some alternative
contact information.

E-Mail =
The Fastest Way to Never Get a Reply
Incidently, I do not recommend you initiate contact via e-mail even
if a therapist provides an address for doing so. There are a number
of reasons I advise against this. First of all, e-mails aren't the most
secure form of communication. Even if you sent an encrypted message,
there may still be a copy of it somewhere on your computer that could
be found and read by others with access to your system (this can be
a lot of people you don't even know if you try to send your message
from a company workstation). The main reasons for not sending a therapist
an e-mail message, though, are that many of them don't read their e-mail
or rarely check it. It might be a long time (maybe never) before you
hear back from them. Furthermore, you never know if your message got
filtered by spam-blockers or virus software either - the therapist may
never have even received your message. While e-mail contact may feel
"safer" because of the feeling of anonymity surrounding it,
the telephone is still the best way to make initial contact with a therapist.

Let's Play
20 Questions!
Once you get to speak with a prospective therapist in person, ask them:

How many gender
patients do you have?

How many TS
people have you recommended for surgery?

How long have
you been working with gender patients?

What is your
educational background?

What books
on transgender issues most influenced you?

Have you written
any books or articles on the subject?

What got you
interested in working with transgender people?

What is your
basic philosophy about how to treat this condition?

Do you follow
the Harry Benjamin Standards of Care?

What is your
hourly rate?

What length
of session do you usually prefer?

Is it possible
to do longer or shorter sessions?

How long do
you usually see patients before you might OK them for hormonal therapy?
SRS?

Are you affiliated
with any endocrinologists or plastic surgeons?

Are you part
of my insurance network?

Would you be
willing to classify our sessions as depression in order to meet
insurance requirements?

What are your
hours?

Do you have
weekend or evening appointments?

Do you work
from your home or from an office?

(Anything else
you want or need to know)

AVOIDING
PITFALLS

There have been
a lot of gender patients who've been totally screwed over by their therapists.
The general concensus is that NO therapy is better than BAD therapy.
Below are some of the pitfalls often faced by gender patients seeking
therapy:

The "Gate
Keeper"
Gate Keeper therapists are those that actively try to prevent gender
patients from transitioning. Some of the reasons a therapist may be
a Gate Keeper:

The therapist
is actually prejudiced against transgender people and the gate keeping
is employed to purposely frustrate the patient in the hope they will
simply give up on trying to transition.

The therapist
is actually well-intentioned but misguided by a belief that all peripheral
psychological problems must be addressed and "fixed" before
tackling the gender issues. This is often a bad approach given that
many of the peripheral problems can stem from the underlying gender
issues, so failure to address the gender issues means the peripheral
problems persist.

The therapist
believes the patient does not actually have a Gender Identity Disorder,
and therefore transition is inappropriate therapy. If a patient suspects
their therapist is gate keeping because they do not believe that GID
is present, they should either insist the therapist render a diagnosis
or seek help from another therapist.

MisdiagnosisIf the therapist rendered a diagnosis of "Borderline Personality
Disorder" (or some other personality disorder) or "Body Dysmorphic
Disorder" the patient should definitely seek a second opinion.
Misdiagnosis is more likely to occur with a therapist with little or
no experience treating patients with gender disorders.

Antidepressants/AntipsychoticsPsychiatrists have something of reputation for trying to medicate
problems away by prescribing drugs. Some, on the misbelief that a patient
with Gender Dysphoria is delusional may prescribe anti-psychotic medications.
Depression (even suicidal depression) is quite common among people with
gender disorders. While anti-depressant medications may help mitigate
some of the depression it is only a "band-aid" that ignores
treating the underlying cause(s) of the depression. GID
does not respond to anti-depressant or anti-psychotic drug therapies.

SOC as LAWthis can often be a method employed by Gate Keepers, though
it may also be used by therapists who are particularly concerned that
they may make a mistake in treating a gender patient. They employ the
Standards of Care - which are intended to be more of a guideline - as
if they are law. The SOC is intended to be somewhat flexible to be tailored
by a therapist for each gender patient, not applied as a Draconian Rule
Book or "one-size-fits-all" form of therapy. Specifically
be wary of therapists who insist patients need to begin their Real Life
Test/Real Life Experience without the benefits of HRT. Note, however,
that in some countries (such as Germany and Italy) the Standards of
Care have actually been incorporated into the laws governing the National
Health guidelines doctors MUST follow.

Your Neighborhood
GIC"Gender Identity Clinics" are not as common in the
United States as they once were, but they still exist in many nations
with National Health systems. These clinics are usually affiliated with
a major teaching hospital and/or University. Some may even still provide
"one-stop shopping" for all your gender therapy needs - providing
a therapist, Endocrinologist, possibly even surgeons - under one roof
(often called a "Gender Therapy Team" or something to that
effect). The potential pitfall with such a Clinic or Program is that
the doctors who participate are often involved in gender-related research
and may be more interested in the patient as a research subject than
in treating their gender issues. There are many reports of people who
have been kept in "transition limbo" for a decade or more
by such programs, allegedly for little reason other than their value
as long-term research subjects, sometimes without being informed that
they ARE research subjects. Another potential problem is if the particular
program or clinic has a "philosophy" about transgenderism
that is outside of mainstream science the patients may be forced to
subscribe to some "pet theory" that is not widely accepted
in order to receive treatment at all. Definitely ask other transgender
people who have experience with such an institution what their experience
was and whether or not they would recommend others seek help there.
Again, in some nations with National Health systems the government
may dictate that individuals seeking gender therapy go through such
a clinic or program. If you discover it has a bad reputation you should
seriously consider seeking therapy through private practitioners.

"Rubber
Stampers"These are therapists that don't really provide any psychological
service to their patients. Some patients actively seek out "Rubber
Stampers" because they're just looking for someone with credentials
to go through the motions as a "formality." The potential
pitfall here may be if a patient actually wants or NEEDS actual psychological
care but does not receive it. A therapist who gives the "OK"
to a patient to proceed with HRT and/or GRS, when that patient wasn't
a good candidate for such therapy, is doing a disservice to the patient
(and technically committing malpractice). More than one regretful post-op
has blamed their therapist for "not stopping" them. The Standards
of Care, while an annoying hurdle, also exist for a reason - to hopefully
screen out those for whom transition is not an acceptable therapy.

"My
Therapist is a God"
Some patients are reluctant to question their therapist or their therapist's
motives. NEVER surrender your own will or judgement to a therapist.
Remember that you are a "consumer" who is paying the therapist
for his or her "expert" services. You have the right to "fire"
a therapist who is providing substandard or questionable service. Don't
be afraid to seek a second opinion or to dump a therapist in favor of
another. The therapist works for YOU, not the other way around!

HASTE!I have yet to hear any transitioner say they didn't wish they'd
started sooner. No matter what age a person is when they decide to transition
they feel they've wasted too many years already. However, being in a
hurry to be done isn't necessarily a good thing either. Things like
coming out to friends and relatives, or seeing the effects of HRT, take
time. There is little to be gained by jumping into living "Full
Time" before one is psychologically, socially, or physically ready
to do so. In fact, rushing into transition can, for some, be a recipe
for disaster (the so-called "failed transition" many people
in the Transgender Community talk about).

OBSESSION
with Reassignment Surgery This can be related to "Haste" as well. There are
people who become absolutely obsessed with having GRS/SRS, to the extent
that they convince themselves that having it will somehow magically
cause society to accept and treat them as their target gender. Here's
something to think about, unless you walk around in public displaying
your genitals (which I'm sure you don't or you'd be arrested for indecent
exposure), in most social situations nobody is going to be able to tell
how your genitals are configured! Whether you've had genital surgery
or not, in most social situations nobody will be able to tell if you're
properly clothed. If you are concerned about your ability to pass for
the opposite sex in public (particularly M2F transitioners), FFS - Facial
Feminization Surgery - would be money better spent toward the goal of
being socially perceived as a woman. The first determination people
make upon meeting someone is what sex they are, and that determination
is largely made based off of facial structure. GRS/SRS, if desired,
shouldn't be the FIRST step in one's transition, it should be a LAST
step. There are transitioners who initially were fixated on getting
GRS, but once they'd been on HRT for a while they found a level of comfort
with their bodies and some even decided to forego surgery altogether
(i.e., they identify as "non-op transsexuals").

Assuming
Transition is the Only Answer - d
Don't fall into the trap of believing that transition is the only correct
therapy to address one's gender issues. There are many different forms
of gender identifications and expressions and transition is not an appropriate
therapy for them all. There have been people who were more crossdressers
than transsexuals, but either decided (or were convinced by others)
that transition to living in the opposite gender role and surgical reassignment
was the ONLY option. Gender patients should first consider the coping
mechanism that is least disruptive to their lives before considering
something like tranition! In medicine the smallest treatment is tried
first, if it proves insufficent/ineffective then a more potent treatment
is tried. All too often in gender therapy patients come into a doctor
and demand the "Maximum Dosage" (GRS/SRS) without first trying
something a little less disruptive (like living part-time in role or
low-level HRT).

Which leads me to
my final point:

THE PURPOSE
OF GENDER THERAPY
Okay, this is going to seem like a rather strange thing to say, but
the purpose of Gender Therapy is NOT to transition
from one gender role to another. It is to relieve the dysphoria (the
unhappiness and distress) the patient is experiencing, and help them
to be comfortable with their social role, identity, and physiology.
Some may only find that relief through transition and gender reassignment.
Others may find that point of relief by some other means. If you transition
and undergo surgery when it wasn't the right therapy for YOU, the end
result may be you're even less happy than how you began. Ultimately,
though, only YOU can make the decision, only YOU must take responsibility
for your actions. But a qualified therapist can play a major role in
guiding you to your personal happiness.